Guy Micco and colleagues (Sept 12, p 872)1 are right to emphasise that, whenever possible, patients near the end of their lives must be free to choose whether their care includes optimum pain relief, or more limited use of opioids with the aim of promoting consciousness and lucidity. However, for most patients worldwide, there is no such choice.WHO estimates that each year 5·5 million patients with terminal cancer and 1 million with end-stage HIV/AIDS die without access to adequate pain treatment.2...